WPCNR MR. & MRS. & MS. WHITE PLAINS VOICE. August 7, 2005: Ric Swierat, Executive Director of Westchester ARC, in White Plains, forwards NYSARC's analysis of the Pataki Administration which they credit with pioneering New York State care for the disabled to a new level, the finest in the nation. Their commentary raises the question of what likes ahead for the disabled, now that Governor George Pataki has elected not to seek reelection. Herewith, that commentary:
GOVERNOR PATAKI’S DECISION NOT TO RUN FOR A FOURTH TERM is a potentially very significant development for programs and services to persons with mental retardation and other developmental disabilities. Pataki is now the nation’s longest serving Governor. “I will follow a new path,” he told a gathering of aides and public officials at the State Capitol .
Through initiatives like New York State CARES, generous trend factors and substantial funding increases in almost every year of his eleven years as Governor, Governor Pataki appears to have singled out services for persons with mental retardation and developmental disabilities for special treatment, making our field in New York by far the largest, most comprehensive field of its kind in the nation.
The Governor decides
By requiring an “Executive Budget,” the New York State Constitution gives the Governor enormous power over state spending. Major budgetary initiatives almost always originate from the Governor. Annual budget battles with the Legislature are over marginal amounts, perhaps 2 or 3% of the total State budget. The Governor’s choices can make or break a particular system of services. Fortunately for persons with mental retardation and developmental disabilities, Governor Pataki chose to make their services into an overriding priority.
The two Governors - Carey and Cuomo - who preceded Pataki, also prioritized services to persons with mental retardation. While their decisions were driven by compassion - Governor Carey now refers to his involvement in our field as his proudest achievement - the Willowbrook Consent Decree, various lawsuits and federal deinstitutionalization mandates helped spur them on. For most of Governor Pataki’s tenure in office, those mandates have been either satisfied or relatively muted.
Willowbrook was closed in 1987, eight years before Governor Pataki took office. When he took office, a total of nine developmental centers were closed. Only two more would close. With little pressure from mandates, Governor Pataki appears to have personally chosen to follow the lead of his Democratic predecessors and expand on their legacy.
Conservative but.......
When Governor Pataki was elected, some advocates were in a panic. They believed that the ascension of the fiscally conservative ex-state senator to the State’s governorship would bring a crashing halt to a protracted period of intensive community development.
They could not have been more wrong.
While Pataki’s first budget marked a slightly more austere direction for our field, his succeeding budgets became increasingly more generous. Then in 1998, the Governor announced the New York State-CARES initiative.
NYS-CARES was the only program of its kind in the nation. It provided a comprehensive solution to a twenty year problem. Specifically, community placements had been devoted almost exclusively to individuals coming out of developmental centers. Individuals living at home, who in a former era would have been institutionalized, stayed at home with increasingly aging caregivers. The waiting list of individuals requiring out-of-home placements grew longer each year.
Each year advocates trouped to the Legislature to request funding for community placements for “at-home” individuals in need of out-of-home care. And each year the Legislature did its best to address the issue. But in New York’s “Executive Budget,” a comprehensive solution had to come from the Governor. And in 1998, to almost everyone’s amazement, Governor Pataki - the fiscal conservative - came forward with just such a solution: New York State- CARES.
Originally, the projected cost of the five year initiative was $225 million. In fact, now that NYS-CARES is completed, it is running at nearly $400 million. The Governor followed up NYS-CARES with NYS-CARES II in 2003.
But that wasn’t the end. Other funding enhancements followed. By 2000 the voluntary mental retardation and developmental disabilities field was receiving “double trend” factors, with increases totaling 7 or 8 or 10% annually. It was surely the most generously funded human services field in the nation.
The next Governor?
In six months, Governor Pataki will submit has last budget proposal for New York State. That proposal could be shaped by presidential ambitions, should the Governor actually have such ambitions. If that is the case, Medicaid - which comprises almost all of the funding to our field - may be a target.
According to Norm Adler, a Manhattan political consultant and one time top aide to Assembly Speaker Mel Miller, the Governor’s “big (political) liability is (huge) spending on Medicaid.”
But Medicaid spending - mostly outside our field - has been a big target for the Governor for a number of years.
Despite that, Pataki has consistently used his enormous budgetary authority to enhance New York State’s service system for persons with mental retardation and developmental disabilities.
That begs the question: how will we be treated by the next Governor?
Conventional wisdom makes State Attorney General Eliot Spitzer the front runner to succeed Governor Pataki. Little is known of his attitude toward services to persons with mental retardation and developmental disabilities. He is clearly aware that those services use enormous amounts of Medicaid. And New York State’s behemoth of a Medicaid program will likely be a huge issue for the next Governor.
Spitzer, in particular, may not be able to escape the Medicaid spotlight because of a New York Times series which faulted him, along with other State officials, for lack of vigorous pursuit of Medicaid fraud and abuse. To shake the image as a Medicaid milquetoast, it is easy to imagine a candidate Spitzer putting forth get-tough Medicaid proposals. And there is always the possibility that a candidate, once elected, will actually follow through with campaign promises.
Also of concern is the fate of top aides to Governor Pataki who were instrumental to the Governor’s policy toward our field. Chief among them is OMRDD’s Commissioner, Tom Maul.
However, Commissioner Maul’s expertise in Medicaid’s intricacies is highly valued, non-partisan and broadly recognized. He previously served under Democratic Governor Cuomo, was retained by Republican Governor Pataki and appears to be in a good position to continue as Commissioner regardless of the party affiliation of the next Governor.
Medicaid Reform
Any new Governor may also have to implement Medicaid reform initiatives should they materialize at the federal level. From the wide variety of possible reforms, almost all include state flexibility for distributing federal Medicaid
funds. That could allow a governor to reallocate those funds among competing interest groups.
Services for persons with mental retardation and developmental disabilities are an especially rich source of federal funding. Governor Pataki has kept most if not all of it in our field.
Whether a future governor uses any enhanced flexibility resulting from Medicaid reform to redistribute federal Medicaid funds away from our services and to other fields, to address what some see as glaring fiscal inequities, is something only time and next year’s elections will reveal.
In either case, NYSARC and the entire field owe the Governor an enormous debt of gratitude.
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID COMMISSION met on Wednesday, July 27 to hold its first meeting aimed at determining how to implement $10 billion in Medicaid cuts over four years, beginning in 2006. The Commission, initially referred to as a “bi-partisan” commission, is being boycotted by Congressional Democrats. CONTINUED MEDICAID ADVOCACY EFFORTS ARE CRITICAL. THEY INCLUDE, submission of personal stories to the State Office demonstrating how Medicaid has helped individuals. Stories are then sent on to The Arc in Washington.
So far NYSARC chapters have submitted 17 personal stories demonstrating the difference Medicaid has made in the lives of consumers. Our goal was for 100 such stories, two from each chapter. If your chapter can contribute, it would be for the benefit of all.
DURING THE MONTH OF AUGUST CONGRESS WILL BE IN RECESS, take the opportunity to visit with your congressperson at their district office to advocate FOR Medicaid and AGAINST Medicaid cuts.
In September, Congress will return and commence making decisions which could have significant ramifications.
Richard Swierat
Executive Director
Westchester ARC
